上海交通大学医学院附属瑞金医院普外科. acute abdomen general name for presence of...
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Acute Abdomen
• General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining)
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Anatomic Landmarks
• Divided in quadrants RUQ, LUQ, RLQ, LLQ
• Anatomic:Epigastrium
Umbilical
Suprapubic (hypogastrium)
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Pain
• Visceral pain is caused by distension, inflammation or ischemia in hollow viscous and solid organs.
• Parietal pain is localized to the dermatome above the site of stimulus and is initially unilateral.
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Pain
• Referred pain produces symptoms, but not signs
• Usually lateralized
• Patterns of pain are based on embryologic sharing of dermatomes
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Multiple Faces of Pain
• Pain can be characterized as:
Sharp
Stabbing
Burning
Heavy
Diffuse
Dull
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Diagnosis
• History
Characterization of pain
Location? Duration?
Other symptoms
Nausea, vomiting? Bloody?
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Inspection
• Description of abdominal habitusscaphoid,
Flat
Rotund
• Scars, wounds, erythema
• Anatomic Confines
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Auscultation
• Listen with stethoscopeNot necessary in all quadrants
• QuantitativeAbsentDecreasedHyperactive
• QualitativeNormalBorbyrigmyObstructiveBruits
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Percussion
• Abdomen Tympanitic gasDull fluid
• Liver Spanmid clavicular line by convention
• Bladder, UterusRising out of the pelvisPercussion is also a very sensitive sign of peritonitis
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Palpation
Prepare the patient
warn them
make them comfortable
take tension off the abdominal wall• Pillow or bend the knees
Expose the entire abdomen• Xiphoid to pubis
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Palpation
• Note the patient’s attitude (physically and emotionally)
• Watch their eyes as you touch them
• After percussion:Softly at first
Deeper• LUQ-RUQ note liver edge
• Then LLQ-RUQ
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Laboratory Studies
Complete blood count
Urinalysis
Serum amylase and lipase
Liver function studies
HCG
Serum electrolytes
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Imaging Tests
• X rays• Flat and upright abdo
minal films (the most common first step)Air
Calcific densities (stones, eggshell)
Mechanical obstruction / ileus
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Imaging Tests
• Ultrasonography• CT scan• Specific organ studies
IVP
HIDA
• Angiography
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Imaging Tests
• CT: 15-20% false negative for acute perforationPoor study for gallstones
Contrast obscures kidney stones
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Undergo Operation
• Signs of peritonitis
• Increasing localized abdominal tenderness
• Abdominal pain with signs of sepsis
• Acute intestinal ischemia
• Certain radiographic findings
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Appendicitis
• Usually due to obstruction with fecalith• Appendix becomes swollen, inflamed gangrene,
possible perforation
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Appendicitis
• Pain begins periumbilical; moves to RLQ
• Nausea, vomiting, anorexia
• Patient lies on side; right hip, knee flexed
• Pain may not localize to RLQ if appendix in odd location
• Sudden relief of pain : possible perforation
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Duodenal Ulcer Disease
• Steady, well-localized epigastric pain
• “Burning”, “gnawing”, “aching”
• Increased by coffee, stress, spicy food, smoking
• Decreased by alkaline food, antacids
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Duodenal Ulcer Disease
• May cause massive GI bleed
• Perforation = intense, steady pain, pt lies still, rigid abdomen
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Kidney Stone
• Mineral deposits form in kidney, move to ureter
• Often associated with history of recent UTI
• Severe flank pain radiates to groin, scrotum
• Nausea, vomiting, hematuria
• Extreme restlessness
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Abdominal Aortic Aneurysm
• Localized weakness of blood vessel wall with dilation (like bubble on tire)
• Pulsating mass in abdomen
• Can cause lower back pain
• Rupture shock, exsanguination
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Cholecystitis
• Inflammation of gall bladder
• Commonly associated with gall stones
• More common in 30 to 50 year old females
• Nausea, vomiting; RUQ pain, tenderness; fever
• Attacks triggered by ingestion of fatty foods
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Bowel Obstruction
• Blockage of inside of intestine
• Interrupts normal flow of contents
• Causes include adhesions, hernias, fecal impactions, tumors
• Crampy abdominal pain; nausea, vomiting (often of fecal matter); abdominal distension
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Gynecologic Disease
• A common cause
• A thorough history
• Complete pelvic and rectal exam
• Plain films of the abdomen
• Pelvic ultrasound
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Thank you